Counting Lives, Counting Deaths
Accounting identities are not sufficient grounds to argue against pro-life laws
Tonight’s Game One for Yankees-Dodgers/Judge-Ohtani/Bronx-Chavez Ravine; should be fun! Welcome to Family Matters. On tap:
The Main Event: Are pro-life laws leading to higher infant mortality?
Teamwork Makes the Dream Work: EPPC’s Jamie Hall writes to Congress
It’s Me, Hi: New York Times, Daily Signal, The 19th, and more
Quick Slants
The Main Event
The twenty-eight months that have followed the Dobbs decision has been a whirlwind. Pro-lifers have made some missteps. So, too, has some media coverage, which has fed into an atmosphere of distrust and misinformation. A recent research letter in JAMA Pediatrics is providing grist for the usual narrative creation that leads to heat rather than light.
Ohio State epidemiologists Parvati Singh and Maria F. Gallo found evidence for a post-Dobbs bump in infant mortality nationally, similar to what prior research had found in Texas. Their finding of a seven percent increase in infant mortality was uncritically reported by major media outlets suggesting laws intended to be “pro-life” were somehow backfiring and leading to more infant deaths. I dislike doing the Twitter nutpicking thing, but you can imagine the kind of reaction this sort of headline received from people alleging pro-lifers ‘only care about the baby until it’s born’:
But the researchers’ work shows a fairly straightforward story. In the average month since Dobbs, there were 247 more total infant deaths than would have been expected prior to the decision; 204 of those additional deaths per month were due to chromosomal and genetic conditions that led babies to be born with little to no chance of survival.
In other words, the apparent “increase” in infant mortality post-Dobbs was, in large part, not because of an overall rise in infant deaths. It was predominantly due to the fact that these infants were not being killed in utero, and thus not counted as in the infant mortality statistics.
One cannot easily imagine the heartache and agony that must course through parents’ veins as they meet with an ultrasound tech who gives them convincing evidence their baby has a condition that will prove fatal. These tests, of course, aren’t perfect; there are people with trisomy-18, spina bifida, osteogenesis imperfecta, and other conditions deemed incompatible with life that live for years beyond what medical experts predict. But these tests often do lead to truly worst-case scenarios.
Diagnoses of conditions that are deemed incompatible with life are frequently made very near the point of hypothetical viability. So the decision about whether small, unborn beings should count, from the standpoint of statistical legibility, ultimately hinges on whether their lives are wanted or not. One baby, born prematurely and with a fatal disability at 22 weeks, gets tallied in the numerator of “infant mortality,” while their peer with the same would-be-fatal condition, aborted a week later, makes it into the epidemiological statistics only as intentionally-induced fetal demise. Uncritically accepting this illogic at face value is the only way to argue that abortion bans are causing an increase in the number of dead kids. It’s using accounting identities to paint pro-life laws as counterproductive or heartless.
In other words, the “increase” in infant mortality post-Dobbs was, in large part, not because of an overall rise in infant deaths. It was predominantly due to the fact that these infants were not being killed in utero, and thus not counted as in the infant mortality statistics.
This whole approach has more than a slight parallel to coverage of the “elimination” of Down syndrome; in Iceland, famously, just two or three children each year are born with Down syndrome due to eugenic abortion. In the U.S., approximately two-thirds of fetuses that test positive are aborted, thereby reducing the incidence of Down’s at the population level. When U.S. states passed restrictions on abortion prior to Dobbs, rates of Down’s syndrome went up because fewer babies testing positive were being aborted, not because of environmental or population factors.
Bias in coverage of fertility and family is nothing new. Take the recent, tragic death of Amber Thurman, a Georgia woman who died after complications from the abortion pill. Initial reporting suggested that the state’s post-Dobbs law tied the hands of doctors who were unable to save her life. A closer read of the story suggests that while the recent legal changes might have contributed to some confusion, Thurman’s death was due to improper medical care, not Georgia’s law. As EPPC scholar Mary Hallan FioRito writes with Ob/Gyn Monique Chireau Wubbenhorst:
“Thurman was not experiencing a miscarriage. She had undergone an abortion. Her unborn twins had already died, and she had retained parts of their bodies or the placenta — a known complication of abortion pill use and one of the very reasons for the FDA’s requirement for a post-abortion follow-up visit with a doctor…A [dilation and curettage] for retained fetal parts or placenta is a commonly performed gynecologic procedure, not a crime or ‘a challenge’ — either before or after Dobbs v. Jackson.”
Pro-lifers who have been concerned about the Biden administration’s post-Covid expansion of access to mifepristone see in the awful and avoidable death of Amber Thurman an example of just why abortion-inducing drugs should be monitored for complications, not made increasingly available with few regulatory safeguards. But that angle doesn’t get much play in the heat of an election year.
Similarly, it is true, as The Free Press’ Olivia Reingold reported, women in rural Alabama are finding it unacceptably difficult to receive obstetric care as labor and delivery units close.
But this largely is due to demographics, not Dobbs; deep blue states like California and New York have also seen new parents have to make hours-long drives for OB care thanks to shuttered maternity wards. As Ivana Greco ably covered for COMPACT magazine, the prime dynamics at play are low Medicaid reimbursement rates and declining birth rates. Focusing only on red states only tells one part of the story.
Sick kids and dead babies are the ultimate in heart-wrenching tragedies you wouldn’t wish on your worst enemy. There are no easy answers. Take a story from reporter Shefali Luthra’s recent book “Undue Burden.” She profiles a Kansas City mom who flew to D.C. for an appointment at one one of only a few sites that would preform a late-term abortion on her fetus diagnosed with a fatal abnormality. Luthra recounts that the mother opts for “an injection that would stop [her son's] heart.” When she returns to Kansas for a follow-up, “she didn’t tell the nurse on duty that she’d gotten an abortion. All she said was the truth: ‘We can’t find his heartbeat.’ The tears she cried were real.”
Progressives, on the whole, believe that parents should have the right to seek this kind of termination of pregnancy for therapeutic or eugenic reasons when a fetus is diagnosed with a severe or likely-fatal condition. Conservatives tend to believe the intentional stoppage of an unborn human’s heart is nothing less than killing an innocent who deserves life, however fleeting.
These are gut-wrenching realties and deep-seated philosophical differences that, ideally, would be able to be sorted through in ways that didn’t inflame political battles. But given the current context, we can, at the very least, aim to ground our political debates in honesty.
Basing the argument that pro-life laws are inhumane atop what are, essentially, accounting identities should be seen through for what it is — an attempt to launder a given worldview through the language of statistics and sympathetic media coverage. It assumes there is no debate about the legal and ethical status of those unborn who are fated to experience a life of severe disability or worse, and as such that the soft eugenicism of late-term abortion for fetuses with disfavored characteristic is the only rational approach. Our bioethics debates deserve better.
Teamwork Makes the Dream Work
Last week, I highlighted a strength-in-numbers approach to Congressional outreach, with a number of leading social conservatives encouraging Congress to increase the size, generosity, and reach of the Child Tax Credit. My EPPC colleague Jamie Bryan Hall also recently weighed in on pending tax plans in a letter to Republican lawmakers.
One aspect in particular of his letter is worth highlighting. Conservatives often (rightly) draw attention to marriage penalties facing low-income households in the tax code. But Hall notes that in cases where a wealthy taxpayer marries someone making little to no income, they could receive an implicit marriage bonus on the order of tens of thousands of dollars. He offers a handy rule of thumb:
The tax computation for married couples filing jointly should be adjusted so that the benefit of adding a spouse to the tax unit does not exceed the benefit of adding a child
In a progressive income tax system, there will always be tensions between treating marriage fairly while also taxing the rich relatively more than low- and moderate-income families. Finding that delicate balance — to encourage strong family formation for working-class households without handing out over $30,000 in tax breaks to the wealthiest households — requires some clever policy work. Congress doesn’t appear to be interested in doing that level of homework any time soon; but I have an inkling that Jamie is. Stay tuned.
It’s Me, Hi
For the Daily Signal, I review “Sex and the Citizen,” a new book taking a global view of marriage and its postmodern critics, by Washington Examiner editor Conn Carroll:
Marriage is no longer about how best to order society to support the children male-female romantic partnerships inevitably produce, and is instead about increasingly surpassing the bounds of tradition and biology in the name of autonomy.
For the New York Times, Claire Cain Miller spotlights the surprising common ground on pro-family policy between the Harris and Trump campaigns, including a larger CTC, more money for child care, and support for paid leave:
Mr. Vance epitomized this shift at the vice-presidential debate, when he was asked about child care and gave a response that sounded very unlike traditional Republicans: “We’re going to have to spend more money.”
“If you put that up for a vote tomorrow, it’s not going to pass,” said Patrick T. Brown, a fellow at the Ethics and Public Policy Center, a right-leaning policy group. “But if you compare where we were five, 10 years ago, the center of gravity is unquestionably shifting, with the focus on families and fertility post-Dobbs.”
For The 19th, Chabeli Carrazana writes on how parents do and don't fit into normal campaign outreach, and whether this year might be different:
“Normal people don’t think about their daily life in political terms — similarly with child care. ‘Man, child care is so expensive’: A lot of people don’t necessarily think of it as a policy failure that needs to be addressed,” said Patrick T. Brown, a fellow at the conservative think tank the Ethics and Public Policy Center.
For TaxNotes, Cady Stanton highlights our recent letter on pro-family priorities for the upcoming tax negotiations:
The Niskanen Center and the Ethics and Public Policy Center focused their letter on what they hope to see for a CTC expansion. Their priorities include increasing the credit value to $3,000, eliminating head of household filing status, expanding Social Security number requirements, expanding the credit to time of childbirth, and removing the cap on how much can be claimed as a refund. The TCJA doubled the value of the CTC from $1,000 to $2,000, but that provision is one of many set to expire at the end of 2025.
AEI’s Kevin Corinth replies to our recent CTC letter by pointing out one of the provisions could exacerbate marriage penalties:
These three reforms are productive ways to increase the generosity of the credit, including for families with lower incomes. The same cannot be said for the fourth and final reform to the Child Tax Credit, which would phase in the refundable portion on a per-child basis…The per-child phase-in would lead their full package of reforms to substantially increase marriage penalties for working single moms with multiple children.
Grace Porto of Catholic Vote highlights our recent joint letter on improving the Child Tax Credit.
And I always knew those hours of being subjected to First Take in the dining hall would come in handy, such as when USA Today included my Stephen A. Smith tweet in their roundup.
Quick Slants
Based on reader feedback, going to try something a little different this week — instead of the usual staid, even prosaic, collection of valuable family policy-related links, here’s a link and one line of commentary. If you like this better or worse than the usual roundup, let me know!
Nate Cohn weighs the polling evidence that young men are shifting to favor Trump over Harris, though it’s sensitive to small subgroup size; though even if the trend is real, whether or not they turn out to vote is an open question. (New York Times)
Lyman Stone and Brad Wilcox offer their pro-natal policy prescriptions for 2025. I endorse them all, but they pale in comparison to my preferred pro-natal policy, an explicit and up-front bonus for new parents. (Institute for Family Studies)
Rachel Bovard correctly notes that Republicans should prioritize flexibility for parents in ways that go beyond the simple “working mom vs. SAHM” false dichotomy, though she leaves policy specifics to be filled in. (First Things)
Patricia Snow examines Taylor Swift through the lens of the sexual revolution; if it’s not the best out of everything that’s been written on the Swift phenomenon (Family Matters included!), it’s very close (First Things)
My EPPC colleague Erika Bachiochi criticizes the tendency towards misogyny from some on the political right, and suggests that both progressive women and too-online men would benefit from recognizing the benefits of authentic, as opposed to nominal, religious belonging on men (COMPACT)
Darren Geist dips into autobiography, history, and theology to chart a hopeful future for young men and marriage; a nice compliment to the Bachiochi piece (Public Discourse)
Ann Schimke writes that the new federal child care quality mandates drive costs up for providers, but they aren't matched with additional dollars, meaning fewer dollars overall to serve their eligible population (Chalkbeat)
Kendra Hurley with a detailed look into the economic pressures and overweening regulations forcing many home-based child care providers to the brink - “It almost seems easier for someone to turn their place into a liquor store than a daycare” (Fast Company)
Alex Brill, Kyle Pomerleau, and Stan Veuger of the American Enterprise Institute analyze some of the CTC plans on offer, but the universal $5,000 plan they describe as the "Republican proposal" is based on an off-the-cuff remark from Sen. Vance and there is no evidence it is actually being proposed by the campaign. (Tax Notes)
Cremieux Recueil argues that Italy's move to ban international surrogacy flies in the face of “complete bodily autonomy,” thereby making the point of those who believe surrogacy should be restricted precisely on those grounds (Unherd)
The Athletic staff reports that players in the WNBA are planning to go on strike, seeking to negotiate a larger share of revenue and an easier path to access fertility services like egg freezing (The Athletic)
Send me a postcard, drop me a line, and then sign up for more content and analysis from EPPC scholars.